14-005849 Agency For Health Care Administration vs. Tiki R. Stafford, D/B/A Diversity Me Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Monday, March 30, 2015.

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION 2015 MAY I q A 10: llO

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner, DOAH No. 14-5849

vs. AHCA Nos. 2014007637

2015001509

TIKI R. STAFFORD d/b/a DIVERSITY ME, License No. 11951

File No. 11967998

Respondent. Provider Type: Assisted Living Facilitv

___________________________________ / RENDITION NO.: AHCA- IS ·QJ.Of1 -S-OLC

FINAL ORDER

Having reviewed the Administrative Complaint and Notice of Intent to Deny, and all other

matters of record, the Agency for Health Care Administration finds and concludes as follows:

1. The Agency has jurisdiction over the above-named Provider pursuant to Chapter 408,

Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions.

2. The Agency issued the attached Administrative Complaint and Election of Rights forms

to the Provider. (Ex. 1) The Agency also issued the attached Notice of Intent to Deny Renewal

Application and Election of Rights form to the Provider. (Ex. 2) The Election of Rights forms advised

of the right to an administrative hearing.

3. The parties have since entered into the attached Settlement Agreement. (Ex. 3)

Based upon the foregoing, it is ORDERED:

4. The Settlement Agreement is adopted and incorporated by reference into this Final Order.

The parties shall comply with the terms of the Settlement Agreement.

5. The Provider shall contract with a consultant and fulfill its contractual obligations under

the Settlement Agreement. The Provider's Administrator shall complete the ALF training for Limited

Mental Health Licensure certification course.

6. The Provider shall pay the Agency $2,500.00. If full payment has been made, the

cancelled check acts as receipt of payment and no further payment is required. If full payment has not

been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory

interest and may be referred to collections. A check made payable to the "Agency for Health Care

Administration" and containing the AHCA ten-digit case number should be sent to:

Central Intake Unit

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 61

Tallahassee, Florida 32308

7. Counts II and III of the Administrative Complaint are withdrawn.

8. The Notice of Intent to Deny is withdrawn.

ORDERED at Tallahassee, Florida, on day 2015.

cretary

are Administration

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this Final Order is entitled to judicial review, which shall be

instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy,

along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district

where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be

conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30

days of rendition of the order to be reviewed.

CERTIFICATE OF SERVICE

I CERTIFY that a true and correct __9WY of this Final Orde was served on the below-named

persons by the method designated on this J.E_ day of , 2015.

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Bldg. #3, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone: [phone]

Facilities Intake Unit Anne Avery, Unit Manager

Agency for Health Care Administration Assisted Living Unit

(Electronic Mail) Agency for Health Care Administration

(Electronic Mail)

Central Intake Unit Robert Dickson, Field Office Manager

Agency for Health Care Administration Local Field Office

(Electronic Mail) Agency for Health Care Administration

(Electronic Mail)

Andrew B. Thomquest, Senior Attorney Tiki R. Stafford, Owner/ Administrator

Office of the General Counsel Diversity Me

Agency for Health Care Administration 3225 N. Myrtle Avenue

(Electronic Mail) Jacksonville, Florida 32209

(U.S. Mail)

R. Bruce McKibben Theodore E. Mack, Esquire

Administrative Law Judge Counsel for Respondent

Division of Administrative Hearings 3 700 Bellwood Drive

(Electronic Mail) Tallahassee, Florida 32303

(U.S. Mail)